Sole Proprietor Affidavit for (Colorado) HB 1023 –  
                To Be Submitted with a Valid Form of Identification 
 
I, ______________________________, swear or affirm under penalty of perjury under the laws of the State of 
Colorado that  (check one): 
 
_____I am a United States citizen,    or 
 
_____I am a permanent resident of the United States,     or 
 
_____I am lawfully present in the United States pursuant to Federal Law. 
 
I understand that this sworn statement is required by law because I have applied for a business license with 
the Town of Mountain Village.  I understand that state law requires me to provide proof that I am lawfully 
present in the United States prior to the receipt of a business license with The Town of Mountain Village.  I 
further acknowledge that making a false, fictitious, or fraudulent statement or representation in this sworn 
affidavit is punishable under the criminal laws of Colorado as perjury in the second degree under Colorado 
Revised Statute 18-8-503 and it shall constitute a separate criminal offense each time a business license is 
fraudulently received. 
 
________________________________________        ________________________ 
Signature of Sole Proprietor                                Date 
 
________________________________________    ________________________ 
Printed/Typewritten Name of Proprietor                             SSN or EIN (of sole proprietor) 
 
One acceptable form of identification must accompany this document either presented in person or a LEGIBLE copy sent 
through the US mail.  Forms of Identification acceptable: 
 
Unexpired Driver’s License 
Unexpired Identification Card (issued by the Department of Motor Vehicles) 
Unexpired US Military Identification Card 
Unexpired US Military Family Member Identification Card 
Unexpired US Coast Guard Merchant Mariner Card 
Native American Tribal Document 
 
TMV Office Use: 
 
Document Type:____________________________ Document #_____________________  Exp. Date:_______________ 
 
Verified by:___________________________________________  Date: ____________________________